Cannabis as a substitute for alcohol and other drugs

School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, Berkeley, CA 94720, USA

Harm Reduction Journal 2009, 6:35
doi:10.1186/1477-7517-6-35

Published: 3 December 2009

Abstract

Background

Substitution can be operationalized as the conscious choice to use one drug (legal
or illicit) instead of, or in conjunction with, another due to issues such as: perceived
safety; level of addiction potential; effectiveness in relieving symptoms; access
and level of acceptance. This practice of substitution has been observed among individuals
using cannabis for medical purposes. This study examined drug and alcohol use, and
the occurrence of substitution among medical cannabis patients.

Methods

Anonymous survey data were collected at the Berkeley Patient's Group (BPG), a medical
cannabis dispensary in Berkeley, CA. (N = 350) The sample was 68% male, 54% single,
66% White, mean age was 39; 74% have health insurance (including MediCal), 41% work
full time, 81% have completed at least some college, 55% make less than $40,000 a
year. Seventy one percent report having a chronic medical condition, 52% use cannabis
for a pain related condition, 75% use cannabis for a mental health issue.

Results

Fifty three percent of the sample currently drinks alcohol, 2.6 was the average number
of drinking days per week, 2.9 was the average number of drinks on a drinking occasion.
One quarter currently uses tobacco, 9.5 is the average number of cigarettes smoked
daily. Eleven percent have used a non-prescribed, non OTC drug in the past 30 days
with cocaine, MDMA and Vicodin reported most frequently. Twenty five percent reported
growing up in an abusive or addictive household. Sixteen percent reported previous
alcohol and/or drug treatment, and 2% are currently in a 12-step or other recovery
program. Forty percent have used cannabis as a substitute for alcohol, 26% as a substitute
for illicit drugs and 66% as a substitute for prescription drugs. The most common
reasons given for substituting were: less adverse side effects (65%), better symptom
management (57%), and less withdrawal potential (34%) with cannabis.

Conclusion

The substitution of one psychoactive substance for another with the goal of reducing
negative outcomes can be included within the framework of harm reduction. Medical
cannabis patients have been engaging in substitution by using cannabis as an alternative
to alcohol, prescription and illicit drugs.